Thal
Our first days were spent organizing the medicines supplied by the UN, and writing protocols and procedures for the medic training program. There were still no babies to soothe, no wounds to tend. We didn’t even have a clinic yet. We watched as Mike, an American construction worker, and his crew quickly crafted a rustic structure—a mud-and-grass roof, a floor of swept dirt, and walls made of canvas sheeting strung from ropes laced throughout the clinic. The furniture consisted of old army cots for patients and simple metal tables where we could write.
It wasn’t until the second week that we were able to see patients, and the work, once we began, was challenging. The refugees were a bedraggled group dressed in tattered, threadbare clothes, many of them gaunt and hollow-eyed and desperate for help. It is one thing to see refugees on television, but it was heart-wrenching to see them in person, and I wondered if I could really make a difference here. I had been so sure that I would know what to do, how to help, but in those first days, I lost that cocky confidence and sometimes felt paralyzed by what I was seeing. And who was I anyway, to think that I could really help? Those sad-eyed babies with big bloated bellies that had so moved me already had worried mothers to soothe them. But, I was there. I had to do something.
FM had only one physician, a Brit named Daniel, a thin, quick-witted man who guided the rest of the medical team through the assessment of so many foreign diseases—malaria, typhoid, malnutrition, dysentery. Within days, we were doing what had seemed unimaginable only days before—diagnosing dysentery and worms and occasionally malaria—each of us clutching our handbooks as we plowed through the list of waiting patients. As each day passed, my confidence grew. It would be okay. I would be okay.
And I proved that to myself one bright morning when I was summoned for an emergency. “Miss! Come here, miss!” One of the Afghan medic students frantically waved his arms and motioned for me to follow him. I adjusted my head scarf and hurried after him to the entrance. Already, I could see a crowd hovering there. A baby’s cry rose above the din, and as I approached, a sudden hush fell over the scene. I moved closer and the group parted, revealing a young man holding a baby out to me. The baby, from what I could see as I quickly cradled him, had a large, gaping head wound, with blood and gray matter that seemed to be spilling out from his skull. The father was speaking quickly, the student trying to keep up. “He fell,” the father cried as we rushed to the back of the clinic.
As I stopped and leaned down to place the baby on the cot for a better look, the lump of gray matter fell to the dirt floor. My heart stopped. The baby cried, and his father reached for the tissue in the dirt.
“No,” I shouted. “Leave it.” I knew we couldn’t replace it in the baby’s skull. I didn’t want this distraught father to try. He seemed not to have heard or understood me. Gripping the gray squishy lump in his hand, he reached for the baby’s head. Still holding the baby, I turned away. The baby screeched and flailed about. It was then I saw a long gash in his scalp that surely needed stitches, but there was no evidence of a more serious injury, and no sign that his brains had leaked out. The wound was superficial. I rocked the baby and turned questioningly to the medic, who was laughing.
“Che ast?” ‘What is it?’ I asked.
The father held the gray hunk out for me. “It is the liver of a goat. We put that on a wound to keep it clean and to stop the blood. “Famidi? Understand?” the medic asked.
I didn’t really, but in a way, it made sense. The blood’s clotting factors are produced in the liver. The animal liver may have helped stem the bleeding, and at least protected the wound from the dirt that was all around us. We irrigated, cleaned, and sutured the wound the only way I knew—with saline and stitches and bandages.
“Tashakore,” the father said as he lifted the baby into his arms. He slipped the little envelope of antibiotics we’d prescribed into his shirt pocket and turned to leave.
“Come back,” I cautioned, “if there are any signs of infection, and in seven days, we want to take those stitches out. Understand?”
The father ignored me. I had done what was needed, and now I was just a female again. The Afghan medic repeated my instructions, and the father nodded. The baby squealed, delighted to be done with us, and I heard his laughter as father and son were on their way back home, but home was a worn and dingy tent with a dirt floor. We had yet to develop a record-keeping system, so we never got the family’s name, and I knew it was likely we’d never see them again. This baby and his father were blunt lessons in understanding the realities and limits of delivering health care amidst chaos, especially as a woman in a land where women were not to be heard or seen.
Our days were full. Refugees and locals walked for hours just for the hope of medical care. For others, who really weren’t sick, a visit to the clinic provided a break from the hellish monotony of life in the camps. For the women, each day was filled with reminders of all they had lost—their homes, their husbands, sometimes their children. Once surrounded by large, extended families in thriving villages, they were now forced to live in small tents or mud houses with their remaining family members. A visit to our clinic allowed them a glimpse of foreigners and provided gossip for days to come. I could see the women, hidden by their veils, their shoulders shaking with laughter, as I fumbled with my head scarf or the baggy pants I wore under my dress.
Asma was among them, an older woman who’d walked to our clinic one day, not because she was sick but rather because she’d heard about the foreigners in Thal and wanted to see us for herself. She wore a threadbare dress, a grimy head scarf, and plastic sandals. She took a number, and when I called her in, she rose, leaning her thin frame on a crooked wooden stick. She followed me into the clinic and sat heavily on the old cot.
“Salaam-aleikum, chetore asti? Khoob asti? Jon ‘a jurast?” I greeted her. ‘Hello, how are you? Are you well?’ I’d been learning Dari, enough that I could sometimes get by on my own.
She nodded and shrugged her shoulders. “Waleikum-salaam. Khoob astam.”
“Che taklif em rosa?” ‘What is your problem today?’ I asked, reaching for my stethoscope.
“I have no problems,” she said haltingly in a mix of English and Dari.
“You speak English?”
“Kam, kam, a little.” She swiped the end of her head scarf across her brow. “I am Asma,” she said. “I am from Afghanistan, a beautiful place. Not like this,” she added, casting a scornful eye around the clinic. “I am here for a short time. You understand?”
I nodded and set my stethoscope back down.
Asma smoothed her dress and wrinkled her nose. “This dress,” she said, tracing her finger along the worn fabric and what remained of the fancy beads sewn into it, “was new not so long ago. It was my best dress, the one I wore for Eid and other happy occasions, but now it is only a rag. Ours is a hard life. You understand?”
And I nodded again, though I couldn’t even imagine how hard it must be for these women who had been forced from their homes, from everything they knew. Their children—if not injured or sick—were hungry, their husbands at war, their land lost, their homes destroyed. How could I, how could any of us, who would all eventually go home to warm, safe homes, ever really know the extent of their suffering?
Asma looked me straight in the eye and continued. “I had a trunk full of fine clothes once. I had a garden and flowers and a fine house, and now I have nothing. My husband is all I have left, and even he is not the same. Famidi? I was somebody important.” She dropped her gaze to her hands and sighed. I reached out and pressed my hand on top of hers, a display of understanding, I hoped.
“Why are you here?” she asked me, her eyes suddenly flashing. “Why would you, why would any woman, leave her home to come to a country of strangers? Are you rich? Or maybe bored?”
I pulled my hand away and tried to explain that I was a nurse at home, that I came here only to help. And contrary to being rich, this trip—at my own expense—just might break the bank, but already, I knew that I loved being here, that this work mattered. “I’ll have to work twice as hard when I go home to save up so that I can do this again. Understand?”
She smiled—finally—and reached into a pocket, her fingers fumbling for something, and when she found it, she rolled it into the palm of her hand and held it out to me. “Chickpeas,” she said proudly. “For you. It is all I have to say thank you.”
A flush rose to my cheeks. We had food here, and though we all complained about the beans and rice and occasional chicken that had seemed to die of starvation, it was still food. I’d never known real hunger, and I hesitated. “I . . . I can’t . . .” I started to say until a cough interrupted me. It was one of the interpreters who had happened by. “You must take them,” he whispered. “To refuse is a terrible insult.”
Chastened, I held out my hand and Asma dropped the peas there. “Can I do anything for you?” I asked, my fingers closing over the gift.
She shook her head. “The only thing I need now is to go home, to work in my garden again, and to die in my own land.” She adjusted her head scarf and stood, pulling her stick close.
“I would help you if I could, but I hope you know I won’t forget you,” I said.
“I think you will forget me,” she answered matter-of-factly. “You will go home and inshallah, I will, too,” she said softly as she hobbled out and away.
But I haven’t forgotten her, and I’ve always wondered if she made it home before she died, if she had a chance to work in her garden and feel the sweet soil of her own land in her hands once again.
And there were so many others, too—hungry babies, exhausted women, war-weary men and boys—none returned for follow-up. I worried about them all—the baby with the head wound, the old man with the worrisome cough, the young woman with five tiny children in tow who’d left the clinic before we had a chance to speak with her—and the rest we’d seen so quickly in our clinic. Although I’d barely had a glimpse of most of them, they’d all made a lasting impression.
My four weeks here had passed in a rush of long days and longer nights. The sounds of war, of mortars and Kalashnikovs, had taken some adjustment, but I was already sleeping through most of it. I was still relieved to hear the gunfire and missiles and mortars during the daylight hours; it was fast becoming almost normal background noise, and it made it less likely that they would fight again that same night, meaning a peaceful sleep for me. And although the echoes of war were distant, I had learned to distinguish the difference between the sounds that marked incoming and outgoing missiles and rockets. Incoming was characterized by a whistling sound, while outgoing was signaled by a bang and a whoosh. And luckily, none ever came close to us.
When I left Thal and returned to Peshawar on my way home, I learned that I would now need exit papers to leave Pakistan. God, what a country this was. I didn’t know why they couldn’t just make one set of rules and leave it at that. The procedure to get exit papers was long and involved, and at the American Club, with the courage of several glasses of wine under my belt, I said the hell with it. It seemed a brilliant decision at the time, but as soon as I got to the airport and saw the fierce men stamping passports, I regretted my alcohol-fueled show of bravado. I was determined though to get on that plane, so I hung back and watched the process. I’d learned enough in my four short weeks to know that surely not all of these men could read. I watched until I noticed one man who seemed not to be reading the documents or papers, only glancing quickly. I scurried into his line and when my turn came, I smiled broadly, chattered away in English, and gave him every paper in my possession, including my FM curriculum, TB treatment guide, and more, and I watched warily as he shuffled through. Finally, he gave up, stamped my passport, nodded and pointed the way toward the departure terminal. I could have shouted with joy, but instead, I smiled. I’d outwitted the airport rules, not once but twice. I was feeling pretty cocky once again.
I returned home forever changed—more confident and yet less sure of the direction of my own life. Supermarkets and malls were too crowded and offered too much of everything and too many choices. At work, I was distracted—wondering about Asma and the others, and how they were doing. I spent hours writing to politicians and speaking about the refugee crisis in Pakistan. There was something so honest, so pure, about those refugees, who, though they had nothing, lived with a kindness and courage that was life-affirming. I knew I’d go back, and though it was difficult to explain to family and friends—who still lamented my crazy decision—I was hooked. I couldn’t convince others how right it had felt—I’d already seen their eyes glaze over the few times I’d talked about it—so I avoided the conversation altogether save for one old boyfriend, who understood. “You’re never so alive as when you’re living on the edge and risking it all to help,” he said, referring to his own time in Vietnam at the end of that war. “You can feel it in your bones, right?”
And that was it—in a nutshell. I’d never been more alive than I’d been with the refugees. John had put into words everything I’d felt.
At last, someone understood.
I saved my money, paid my bills, was allowed a little extra vacation time, and finally, I was able to make arrangements to return to Pakistan right after Christmas. And as I packed, my pulse quickened and butterflies flapped in my stomach, and I realized that, for me, going back to the refugees was a little bit like falling in love. How could I ever say no to that?
When I returned to Thal in winter, a living compound had been built across the road. I would share a real, though very bare, room with Ella, and a Western bathroom with everyone else. Real toilets and showers with doors had never looked better. And a hospital with six inpatient beds, an ER, and an OR was almost done. There were two new additions to the staff—both Afghan physicians. The medic students were coming along nicely. They were halfway through their six-month course and already were suturing wounds, treating dysentery, and learning to start IVs.
I slid easily into my old role in the clinic, where one of my first patients was Rahima, a young woman who, like so many others here, had no idea how old she was. She’d only shrugged her shoulders when I’d asked. Few of the refugees, and fewer still of the locals, seemed to know their exact age. They didn’t celebrate birthdays and found it funny that we did. When pressed, they could guess that they were about a certain age, or that they’d been born in the year of the flood or a drought, or during a crop failure, or maybe during an especially full moon. Beyond that, they simply didn’t think about it and couldn’t imagine why it mattered. They were puzzled when we pressed them for an age. You were either old or not, what else mattered?
Draped in the folds of a heavy burqa, Rahima sat quietly, only lifting her veil away when we were alone and there was no chance of a man catching a glimpse of her. Her face was all angles and hard edges. She had deep onyx eyes lined with black kohl, eyes that should have sparkled and shone but instead were as flat and dull as the landscape. I introduced myself and asked what her problem was. She lifted her eyes to me and spoke in a rush of words, too many and too quickly for me to follow. Her list of complaints seemed endless. When I rose to fetch an interpreter, she wagged her finger at me. “Nay, nay,” she said. She somehow knew that our interpreters were men and, as I’d soon learn, she was embarrassed that a strange man would know what it was she’d come about.
“Balay, yes,” I said, calling for Halim. “Otherwise, I’ll never understand what you need. He’ll stay just outside. He won’t see you. Famidi?”
She nodded and we began, Halim translating her every word.
“I am married,” she said softly. “It has been five years now and . . .” Her eyes darted to the doorway, checking to be sure that Halim could not see her. “And, my husband is unhappy with me.” Her eyes filled up, her lips quivered.
“Aacha, it’s okay,” I said, encouraging her to go on. “You’re safe here.”
Her shoulders slumped. “We have no babies,” she said. “I have not been with child, not ever, though my husband and I have been together in that way many times. Do you understand? In my culture, this is very bad. This is why men take second and even third wives, and the first is all but left alone, shamed and untouchable.”
I’d heard this rumor before—women were only as good as the babies they produced, and the more sons, the better. For Rahima, even a daughter would be a blessing.
“I’ve come here today because I know you can help. Foreigners have special ways. I’ve heard it whispered that you can help me to get a baby to grow in there.” She patted her flat belly as she spoke. “Will you help me?” Her eyes were pleading when she spoke.
I swallowed the sorrowful lump in my throat. We could provide only the most basic of care here in Thal. I could suggest that maybe Peshawar or Islamabad could offer those services, but it seemed unlikely that she could afford the cost even if they did. In as gentle a manner as I could, I explained that even when our hospital was open, we would not be able to provide the special services she would need.
“Not ever?” she asked.
I shook my head. “Not ever. But don’t give up—”
She stood, hastily pulling her burqa over her face. “I must go,” she said, her voice cracking, and I understood what she already knew—that she’d be the forgotten first wife reduced to cooking and cleaning for whoever followed her into her husband’s house as his second wife. And that was only if she was allowed to stay. Some first wives were cut off, forced to return home to families who’d have to bear the shame of an abandoned wife under their roof. She would be unmarriageable, an embarrassment and a burden on her family. And there was nothing that I could do to save her.
It was a heartbreaking encounter—for each of us.
The winter was cold, the air especially bitter in Afghanistan, and for a time we were inundated with war-weary young men, with frostbite wounds to their feet. Plastic sandals were the standard footwear in their country, and though the lucky ones had socks, the snow and ice eventually seeped through, freezing the tissue until it blackened and died. When they hobbled into our clinic, many with deep infections in the necrotic flesh, we could only debride the wounds before sending the men on to Peshawar, where many would undergo amputations. As with most of our patients, we’d never see them again, but one young man, a first-time visitor to our clinic in Thal, helped us understand what might have happened with many of them.
Abdul was about twenty when he came to our clinic complaining of leg pain.
“For how long?” Ezat, an Afghan doctor new to our team, asked as Abdul settled himself on the cot. “Since they cut it off,” he said, wincing as he pulled his pant leg up to reveal a vinyl leg that reached to his thigh. He pointed to the area where the prosthetic met his stump. A dirty strap and old ACE bandage held it in place. The odor of old sweat and unwashed skin filled the small room.
“When was that?” Ezat asked as he reached to undo the straps and wrapping that held the stump to the artificial leg.
“No!” Abdul shouted, pulling his leg back. He grimaced with the sudden movement. “Don’t touch me. Just take the pain away.”
Ezat tried to explain that we had to see the stump to understand why he had pain.
Abdul crossed his arms and shook his head. “I haven’t taken my leg off since they put it on in Islamabad two, maybe three years ago.”
“Why?” Ezat’s brow wrinkled.
Abdul’s expression softened. “I stepped on a land mine in Afghanistan, and in a moment, my leg was gone.” He straightened his vinyl leg. “This is all I have now, and without it, I cannot even walk by myself. Do you understand? Without this, I am nothing. With this, you might see me and never notice that I am different. Understand?”
Ezat nodded. “But if you never take it off, if you don’t let me take it off now, you might lose even this. Understand? Things could get worse for you if your stump is unable to support a prosthetic.”
Abdul finally relented and allowed Ezat to remove his artificial leg. Two large skin ulcers marked the end of his stump, the area that bore the pressure of his prosthetic. “You see this?”
Abdul’s eyes avoided the stump. “Can you just fix it?” He looked at me and not at Ezat. It was Western medicine he was looking for, not the same old care he was used to.
I glanced at Ezat, seeking the approval I would need to answer. He nodded and I turned to Abdul. “We can give you antibiotics and ointment to soothe those ulcers, but you must remove your vinyl leg and wash your stump, at least once a day. It’s important. Do you understand?”
He looked, finally, at his stump and shrugged. “Inshallah,” ‘God willing,’ he said as he adjusted his prosthetic, pocketed his medicine, and shuffled away.
And, with little time to think about what might happen to Abdul and his vinyl leg, I was on to my next patient—a tiny little girl named Mariam, who was carried into the clinic by her father. Her mother, hidden in the folds of a faded burqa, remained in the shadows. Only her hands—balled into tight fists and pressed together—gave away her worry.
“She is sick,” her father said, running his fingers through the coarse, dry strands of the little girl’s hair. He unwrapped the small, dingy blanket that covered her, revealing a mere wisp of a child. Mariam was stick-thin with translucent skin, and her fragile bones looked as though they might snap at my touch. Her father lifted her shirt and I caught a glimpse of her bloated belly. She let out a shriek as I leaned in to look in her eyes, the membranes there a pale, almost white hue instead of the healthy bright pink of a well-nourished child. She wasn’t just malnourished; she was starving, and there was little I could do for her. In those days, we had no nutrition programs, no way to feed the hordes of starving here along the rural edges of the Afghan border. Food was provided by the World Food Programme (WFP), and only to those refugees who’d registered with the UN or were living in one of the crowded camps.1 The rest, afraid to register as refugees and be sent to crowded camps, were on their own. Mariam was, and remains, the hardest kind of patient to see. I had medicines aplenty, but this little girl needed food and I had none to give. Food was available in Thal and throughout Pakistan—for a price—so the starvation here was due more to a lack of money than to a lack of food. Aid agencies weren’t allowed to distribute food—only the WFP had that authority. Therapeutic feeding programs for malnourished babies were only then in the planning stages. At the time, all I could offer was a few rupees, but I would be gone soon, the money would run out, and the problem would only get worse, especially here in the deep freeze of winter, when even hope was in short supply.
In those early days, we didn’t track disease or even malnutrition numbers. We had no epidemiologists on staff, we only had anecdotal evidence to guide us. We flew by the seat of our pants, reacting to situations as they arose. All of that would change in time, but not soon enough for Mariam and so many others.
I knew that I had to come back, if only to figure out a way to help the Mariams of the world. I flew home, and without much planning, I arranged to quit my job and work per diem by early summer. I kept the news to myself. People already thought I was nuts. Why throw fuel on the fire? I knew I’d return to Pakistan again as soon as I had saved enough money to cover my bills and maintain my apartment. For someone who’d always been reluctant to do anything on my own, I’d found that I liked relying on myself. There was something affirming about being a solitary traveler through the world’s grittiest spots. I was an aid worker; I could handle anything.
At least, that’s what I told myself.
I returned to Pakistan in the summer of 1987. This time, I would spend the summer, my longest visit yet. My love affair with aid work continued.
On the ride from the airport to the FM house, I noticed, not for the first time, how the crowded streets were filled with beggars. Many of them—just skin and bones and tattered clothes covered with years of dirt—held out their hands and boldly begged. It wasn’t really a shock; we had plenty of our own homeless in the United States and they begged, too, but here it was their only means of getting money. Pakistan didn’t have the government programs we have in the United States. There was no safety net. Many of the beggars here had handicaps, making witnessing their plight all the more disquieting. Those who couldn’t walk dragged themselves around by their arms. If they were lucky, they had a little platform on wheels and they could sit and use their hands to propel themselves. I knew that the best response didn’t involve money, but it was all that I could offer.
On this ride, I saw a withered, dirt-encrusted woman dressed in threadbare rags, dragging herself on stumps of legs through the street. A filthy rag tied about her neck held a sleeping baby. She was a beggar and I asked that we stop so that I could give her money. The Afghan driver reluctantly stopped and let me out. The woman gazed up at me with empty eyes when I handed her the rupees. “Shukria,” ‘Thank you,’ she whispered as she crawled away. The driver shook his head. “Not good,” he muttered. I knew he was right, but how could I just walk away?
I headed out quickly to Thal. The team had changed and now included Rick, a Special Forces medic who bore an uncanny resemblance to Kevin Costner. Tom and the earlier team members had all left; Rick had joined Ella, and until I arrived, they were the team. Others—medical visitors—would come for a very short time, leaving the rest of us little chance to get to know them. Once I arrived at Thal, Ella and Rick each took their Afghan paramedic students into Afghanistan for real-time training with real patients and real injuries, right where they would all eventually be based. I was left in charge in Thal, but it would be the newly constructed OR and ER that would occupy my time. And though the ER would be my home turf, the place I would be most comfortable, it was also the place that moved most quickly, allowing me little time to get to know my patients.
We now had an Afghan surgeon, Majid, on staff so we were able to take some cases to the OR. It meant, too, that more wounded would be brought here, and though we were better equipped than we had been, we didn’t have blood transfusion capability. If someone was bleeding to death, we were helpless. It made me, made all of us crazy. I looked around our storeroom one day and found blood bags and filtered tubing, all necessary to administer blood, but we had no blood-typing equipment, so we were still unable to give blood. I thought about it often. I knew there had to be a solution to this dilemma. I just didn’t know what it was.
One evening, the emergency siren went off and Majid and I rushed to the ER. Our patient was a twenty-year-old male who had been stabbed in the chest during a fight in a nearby refugee camp. Even in war, people argue and fight among themselves. We didn’t need an X-ray to know that he had suffered a collapsed lung and was bleeding into his chest. His blood pressure was dangerously low and his pulse dangerously high, meaning serious blood loss. Without a transfusion, he would continue to bleed and he would die. The surgeon prepared to put in a chest tube to drain the blood and reinflate the lung. Back at home, we would collect the patient’s own blood from the chest tube and transfuse him with his own blood. It is called auto-transfusion and was, and remains, a common life-saving procedure around the world. Majid asked if we could give it a try for this patient.
I nodded and inserted two large intravenous lines into our young patient, then gathered the blood bags and tubing from the storeroom. I cut the filters from the tubing, connected these filters to each other, and then connected this to a donor bag with tubing. When Majid inserted the chest tube, I hooked my lengths of tubing to the end of the chest tube and laid the blood bag on the floor. Gravity and our makeshift equipment worked! Majid, the patient, and I watched in amazement as blood from the chest tube began to drain into the bag. As it flowed, I set up another group of filters and attached this to another bag. To transfuse our patient, I simply connected the filled blood bag to a double-filter and blood tubing and attached that to his intravenous line.
We auto-transfused our patient with three bags of his own blood. We kept him in our small hospital for several days, and then discharged him back to his tent, a little worse for wear, but alive. Although it had been exhilarating to have succeeded, it would turn out to be just another emergency in a summer of so many. There was no time to pat ourselves on the back.
One morning, just as the sun was rising, the siren sounded and we found five patients in our ER. All had been victims of a brutal attack in one of the nearby refugee camps. Rival gangs or Soviet-backed thugs (we were never sure which stories were true) had attacked in the night and hacked away at the residents with knives and machetes, killing many. Those who had survived had hidden until it was safe to escape, finally reaching us just as dawn broke.
My first patient was Aziza, a thirty-something-year-old woman whose husband, we learned, had just been killed during the assault. She had been viciously attacked and had suffered many wounds, the most serious of which was a left arm that was slashed to the bone, her blood seeping into the once faded red dress she wore, now vibrant with color again. Her skin was pale, her lips drawn, her eyes a dull gray. She spoke little except to reply “balay” when asked if she had pain. A man, his hands coated in the stain of old blood, and suspiciously without wounds of his own, insisted on staying in the ER with her. I was wary, concerned that maybe he was one of the attackers, so I asked him who he was. “I am her husband,” he said, an unmistakable arrogance in his voice.
I knew her husband had just been killed, but I wasn’t at home in my own ER. I couldn’t call security to come and haul him out, so I turned to Aziza. “Who is he?” I whispered.
“He is the brother of my dead husband,” she replied softly. I knew that, according to Afghan culture and tradition, he was now her husband. It was a custom intended to protect the woman and her children, but I found it unsettling. Aziza, however, though wounded physically and emotionally, was resigned and calm; I was the one who needed convincing, and I reminded myself that at least she and her children would not be on their own, a far worse fate in this dangerous land.
We worked over our victims for several hours, finally taking Aziza to the OR for repair. Although she probably needed complex neuro-vascular repair, it wasn’t available here. To refer her to Peshawar would mean losing valuable time, which could ultimately cost her the use of her arm. We did the best we could—cleaning, debriding, and closing the wound before discharging her home the next day. She never returned for the follow-up we suggested, and we never learned how her wounds had healed or how her life turned out. Like so many others, she simply disappeared from sight, but not memory.
Weeks later, Rick and Ella returned to Thal just in time for Eid, the Muslim holiday. Out of respect, everything would be closed, including our clinic. We three traveled to Peshawar, noticing along the way how quiet the roads were. In Peshawar, every shop, every business, every stall was shuttered, but we were headed to the American Club for wine and cheeseburgers, or so we thought until we arrived to the dark and empty club. Damn. The club was closed, too.
Our plans awry, we turned and headed to the FM staff house, and there, Ella and Rick, eager for a drink, searched through the house, coming up empty until Rick happened upon the boss’s secret stash of whiskey. He held it up. “Success,” he exclaimed. The three of us—in the house alone and without assigned rooms—decided to pull out mattresses, arrange them in a circle in the living room, and have an adult slumber party. I took a sip of the hard stuff. It burned through to my gut. I shuddered and passed it back, shaking my head at the next go-round. We stayed there, laughing, drinking, and carousing until, one by one, we drifted into the deep sleep that whiskey brings.
In the morning, it wasn’t the sliver of sunlight seeping through the curtains that woke us; it was the boss’s angry shouts. “What the fuck?” he yelled, an angry flush rising from his neck. He’d discovered the almost empty bottle and the three of us stretched out in the living room. We blinked our way awake while he shouted and threatened. “Who opened my bottle?”
We caught each other’s eyes, smiles sparkling there. His anger would wear off. And so we waited and listened until he quieted down and the usual pasty color returned to his cheeks. He mumbled something and left, and the three of us headed to the club for breakfast and Bloody Marys and laughs.
I returned home, even more appreciative of everything that I have here, a place to call home, electricity, a bed, a bathroom, a washing machine, a glass of wine, no one to shout if someone opens a bottle of whiskey. All of it.
But, even with all of that, there was an empty space in my heart when I was away from refugees. It was not unlike that same longing for an old lover, and the separation only made me miss them all the more.